Phobic disorders

The basis of phobic disorders is a constant intense, unreasonable fear (phobia) of situations, circumstances or objects. This fear provokes anxiety and avoidance. Phobic disorders are divided into general (agoraphobia, social phobia) and specific. The causes of phobias are unknown. Diagnosis of phobic disorders is based on an anamnesis. In the treatment of agoraphobia and social phobia, drug therapy, psychotherapy (eg, exposure therapy, cognitive-behavioral therapy) or both methods are used. Some phobias are treated mainly only by exposure therapy.

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Categories of phobic disorders

Agoraphobia

Agoraphobia includes "anxiety ahead", fear of being in situations or places that can not be quickly left or where they will not help in the development of intense anxiety. The patient tries to avoid such situations or, if it gets into them, then experiences a severe anxiety. Agoraphobia can manifest itself either as part of a panic disorder.

Agoraphobia without panic disorder affects about 4% of women and 2% of men over a 12-month period. Typically, the disease begins at the age of about 20 years, beginning at the age of over 40 years is rare. Most often, fear is caused by situations when, for example, a patient stands in line at a store or in a bank, sits in the middle of a row in a theater or in the classroom, uses public transport - a bus or an airplane. In some patients, agoraphobia develops after a panic attack in typical agoraphobic situations. Other patients simply feel uncomfortable in such situations, and panic attacks do not develop or develop much later. Agoraphobia often disrupts the functioning of the patient and, if it is severe, can cause the patient to stop leaving the house.

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Social phobia (social anxiety disorder)

Social phobia is a fear and anxiety to be in certain social situations, to be the focus of attention. The patient avoids these situations or tolerates them with severe anxiety. Patients with a social phobia understand the excessive and unreasonable nature of their fear.

About 9% of women and 7% of men fall ill with a social phobia over a 12-month period, but the incidence of life-threatening disease is at least 13%. Men are more likely than women to develop severe forms of social anxiety and avoiding personality disorder.

Fear and anxiety in people with a social phobia often focus on the embarrassment, humiliation that will arise if they do not live up to the expectations of others. Often, fears are associated with the fact that anxiety can become noticeable through redness, sweating, vomiting or shivering (sometimes a trembling voice), or with the fact that you can not correctly express your thoughts and pick up the right words. As a rule, such actions alone do not cause anxiety. To situations in which there is often a social phobia, include public speaking, participation in theatrical performances, playing musical instruments. Other possible situations include sharing food with other people, situations where it is necessary to sign in the presence of witnesses, use of public baths. With the generalized type of social phobia, anxiety is observed in a variety of social situations.

Specific phobias

A specific phobia is fear and anxiety about a particular situation or object. This situation or object is avoided whenever possible, but if this is not possible, then the alarm quickly builds up. The alarm level can reach a panic attack. Patients with specific phobias, as a rule, understand that their fear is unfounded and redundant.

Specific phobias are the most common anxiety disorders. Among the most frequent phobias, one should note the fear of animals (zoophobia), heights (acrophobia), thunderstorms (astrophobia, bronfoophobia). Specific phobias affect approximately 13% of women and 4% of men over a 12-month period. Some phobias cause minor inconveniences: for example, fear of snakes (officophobia) from a city dweller, if he is not offered to walk around the territory where snakes live. On the other hand, some phobias can significantly impair human functioning, for example, fear of closed spaces (claustrophobia) in patients who are forced to use the elevator while working on the upper floors of skyscrapers. Fear of blood (hemophobia), injections and pain (trypanophobia, belonephia) or injury (traumatophobia) is observed to a certain extent at least 5% of the population. Patients with fear of blood, needles or damage, in contrast to other phobias and anxiety disorders, may develop fainting due to severe vasovagal reflex, causing bradycardia and orthostatic hypotension.

Diagnosis of phobic disorders

Clinical diagnosis is based on the criteria for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).

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Prognosis and treatment of phobic disorders

Without treatment, agoraphobia tends to be chronic. Sometimes agoraphobia can take place without formal treatment, perhaps the comfort of patients whose behavior is somewhat similar to exposure therapy. However, if agoraphobia breaks functioning, then treatment is necessary. The prognosis of specific phobias in the absence of treatment may be different, since it may be easy to avoid situations or objects that cause fear and anxiety.

Many phobic disorders are characterized by avoiding behavior, therefore, preference is given to exposition from various forms of psychotherapy. With the help of a doctor, the patient determines the object of his fear, confronts him and contacts him until the anxiety through addiction gradually decreases. Exposure therapy helps in more than 90% of cases, if clearly adhered to, and is, in fact, the only necessary treatment for specific phobias. Cognitive-behavioral therapy is effective in agoraphobia and social phobia. Cognitive-behavioral therapy includes both teaching the patient to monitor and control distorted thoughts and false beliefs, and teaching ex situ therapy techniques. For example, patients who describe the increase in heart rate or the feeling of suffocation in certain situations or places explain the unreasonableness of their anxiety about a heart attack, and in such situations, patients are taught breathing retardation reactions or other ways of relaxation.

Short-term therapy with benzodiazepines (for example, lorazepam 0.5-1 mg orally) or beta-blockers (usually preferable to propranolol - 10-40 mg orally, ideally they are prescribed 1-2 h before exposure), is especially useful when it is impossible to avoid an object or a situation that causes fear (for example, when a person with a phobia of flights on an airplane is forced to fly because of a lack of time) or when cognitive-behavioral therapy is either undesirable or ineffective.

Many patients with agoraphobia also suffer from panic disorder, and many of them are helped by SSRI therapy. SSRIs and benzodiazepines are effective in social phobia, but SSRIs are probably preferable in most cases, because unlike benzodiazepines they do not interfere with the conduct of cognitive-behavioral therapy. Beta-blockers are useful for immediate manifestations of a phobia.